For a few years it felt like it was mentioned on every other radio or television program. It certainly had the feel of being flavour of the month for a long time. Now, at last, the UK government has decided to give it some official recognition to CBT and has announced a massive cash injection to allow an estimated 900,000 extra people to receive some help from psychological talking therapies. There are plans to recruit 3,600 more therapists.
As a practising therapist who uses CBT, I welcome the move. Official figures suggest that the annual cost of anxiety and depression is Ł12bn, and that at any one time, six million UK adults are suffering, resulting in a estimated 91 million working days being lost every year. I am regularly contacted by potential clients who are tired of being on the waiting list at their local GP Surgery (if they are lucky enough to have a GP Practice that offers counselling). Unfortunately, not everyone can afford to pay a private practitioner. The government money should enable more people to have access to therapy services.
So what is CBT? In broad terms, Cognitive Behavioural Therapy is a way of working with people that encourages them to discover and change untrue and unhelpful beliefs. I may be anxious because I believe that everyone thinks I am incompetent and that I need everyone to approve of me. CBT would help the client to seriously challenge that belief and to replace it with a true and more helpful one. If human beings are iPods on legs, CBT helps people to recognise the tracks they are playing and to change them. People, think, feel, and act, and what you think and do influences how you feel. CBT says: “Let’s take a serious look at what you are thinking and doing. If we can change those, that may change how you feel.”
Although I welcome the increase in the money available for therapy, I would raise a note of caution. Although I have seen one claim that talking therapies are as good as drug therapies for treating depression, talking therapies are not the same as drug therapies, and CBT should not be judged using a medical model.
CBT is not a treatment - something you do to people. It is a way of working with people. The success of any talking therapy is, to a large extent, contingent on the work done by the client (I have deliberately avoided the word ‘patient’). If the client doesn’t engage in the therapy process, regardless of the skill of the therapist and of the particular therapy model used, the therapy will be ineffective. Anyone who dips a toe into the research literature on the effectiveness of therapy will soon discover a loud plea for qualitative evidence to be taken into account, and an acknowledgement of the difficulties of producing quantitative evidence in this area. CBT is not something that you can inject into a person’s head.
I was sent for counselling some years ago. It was a complete waste of time. On the way to sessions I would cudgel my brains to think up “problems” to discuss as I knew the therapist would ask me to “share” my problems with her. I once magnified a trivial incident into a “problem” just to have something to talk about. Unsurprisingly, I finished by discharging myself.
As that was my one brush with counselling, I perhaps ought not draw general conclusions from it though I have heard criticisms from other people and stories suggesting that their experiences were no better than mine.
There are so many schools of therapy all at odds with one another, all arguing about who is right. There is more than a whiff of the religious cult about this. No doubt each therapist thinks his or her own school of therapy represents the unique therapeutic truth but the suspicion is that none of them does.
To my mind it is a criticism of our culture and the education it provides that people seem incapable of facing up to life and learning its lessons for themselves. This, surely, is the way to maturity. If we have to run off for counselling every time we are unhappy at work or unfulfilled in our lives, then it is not surprising that there are so many signs of immaturity in people’s behaviour.
You wrote: ‘I was sent for counselling some years ago. It was a complete waste of time. On the way to sessions I would cudgel my brains to think up “problems” …’
As I argued, the effectiveness of counselling depends on the engagement of the client to some extent. If you were “sent” and if you had it “invent” problems, I am left thinking: 1) it was doomed from the very start; 2) there was nothing to talk about. If I don’t have a toothache, but have to invent one, and if somebody sends me to the dentist, I would tend to think that going to the dentist was a waste of time. Be dismissive of the people who sent you by all means, but it seems a bit harsh to transfer that dismissal to all counselling.
You wrote: ‘There are so many schools of therapy all at odds with one another, all arguing about who is right. ‘
That may be true of some, and I understand the religious analogy. However, many of the counsellors I know practice ‘ecclectically’, drawing from several models, and many of the purists I know are gracious enough to accept the accept difference rather than belittle it. There is a lot of ecumenism about, at least in the circles that I move in.
You wrote: ‘To my mind it is a criticism of our culture and the education it provides that people seem incapable of facing up to life and learning its lessons for themselves. This, surely, is the way to maturity. ‘
To some extent, I agree. However, in reality, many people struggle to do that, and counselling is one way of helping some people grow to achieve their own solutions. The aim of counselling is to foster maturity rather than encourage immaturity.
You wrote: ‘If we have to run off for counselling every time we are unhappy at work or unfulfilled in our lives, then it is not surprising that there are so many signs of immaturity in people’s behaviour.’
We don’t have to run off. Some people choose to do so and are lucky enough to be able to afford to do so. Some choose not to, and others who want to cannot afford it. Given the scarcity of counselling and it’s lack of availability to many who want it (certainly true outside the cities), I don’t think that a picture of everyone running off whenever they feel unhappy or unfulfilled is reality.
So long as the new therapists recognise that CBT is something that we, user and therapist, work on and isn’t something I, the service user, works on.
Its good news and you’ve explained it eloquently, it is just a shame that not everyone is clear on the expectations of talking therapies ( both patient and therapist) to make it widely accepted as a good practice.